Low physical fitness and obesity during teen years linked to disability later in life

1. This prospective cohort study found that both low physical fitness and obesity during adolescence is associated with increased risk for disability later in life.

2. Obesity during adolescence, measured through body mass index (BMI), was found to be the greatest predictor of all-cause disability later in life for Swedish men.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Disability and chronic disease affect a significant number of individuals each year. In many countries, chronic disease can be objectively measured through disability pensions. These are granted to working-age persons who are likely to never work full-time again due to a chronic disease or injury diagnosed by a physician. It is critical to identify early and potentially modifiable risk factors for chronic disease in order to improve population health. One suggested factor leading to disability later in life is low cardiorespiratory fitness in childhood and adolescence. The authors of this study aimed to examine the relationship between individual and combined associations of cardiorespiratory fitness and obesity in male adolescents with later receipt of a disability pension. The authors observed that low physical fitness and obesity in adolescence was linked to disability later in life. This study had several limitations. Of note, the population cohort was limited to Swedish male adolescents; therefore, the results may not be generalizable to female adolescents or other populations. One of the main strengths of the study was its large size, where more than 1 million adolescent males were included in the study.

Click to read the study in Annals of Internal Medicine

Relevant Reading: Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA

In-Depth [prospective cohort]: This study is the largest of its kind, where over 1 million male Swedish adolescents between aged 16 to 19 were included in the population-based prospective cohort study. The authors selected participants who were conscripted to the military between 1972 and 1994 and followed them for a median of 28.3 years. The primary study outcome was the receipt of a disability pension due to all causes. Disability pension due to specific causes was also examined. The authors observed that in total, 54 304 men were granted a disability pension of the 1 079 128 participants included in the study. With respect to primary outcomes, obesity and poor physical fitness individually, as well as the combination, were found to increase the likelihood of later receipt of a disability pension. For example, low cardiorespiratory fitness was strongly associated with disability pension due to all causes (hazard ratio, 3.74 [95% CI, 3.55 to 3.95] for lowest vs. highest fitness decile), as well as specific causes (psychiatric, musculoskeletal, injuries etc.) Additionally, adjusted analyses showed that severe obesity compared to normal weight was associated with a greater risk for receipt of a disability pension due to all causes (HR, 3.21 [CI, 2.49 to 4.15]) as well as some specific causes. The greatest risk was observed for class II and III obesity.

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